Health Affairs February 15, 2023
Analysis from the Medicare Payment Advisory Commission (MedPAC) and others have concluded that Medicare pays less for a patient in traditional Medicare fee-for-service than the program pays Medicare Advantage plans for the same patient. The MedPAC analyses have focused on the greater incentives plans have to include more diagnostic codes and conduct health risk assessments compared to the incentives for providers treating a similar patient in traditional Medicare. The theory: The additional diagnostic codes (coding intensity) in Medicare Advantage result in a higher risk-adjustment score, increasing Medicare payments to the plans. These higher payments result in higher rebates and even more additional benefits for seniors.
The most recent March 2022 MedPAC report (chapter 12) concludes that Medicare pays 4 percent...
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